Short-staffed, unsafe or injured? What the agreement, the policy and the law say.

The employer "commits to introducing minimum nurse/midwife to patient ratios via a phased approach over a minimum of two years (WA Ratio Model)" (WAH042 cl 10(1)). The model aims "to ensure safe and sustainable workloads" (cl 10(2)), and it will replace Nursing Hours per Patient Day (cl 10(3)). The agreement itself contains no ratio numbers and no dates for any phase.

The agreement also says:

(a) once the model is determined in each phase, "it will be implemented without unreasonable delay" (cl 10(6));

(b) the model will include a reporting framework for compliance, keep a ward's existing staffing where an audit found Nursing Hours per Patient Day gave more nurses per shift, incorporate specialty models of care, "in principle" exclude the coordinator from the ratio, and count qualified babies as patients (cl 10(7)(a)–(e));

(c) only registered nurses, midwives and enrolled nurses on Division 2 of the register count in the model (cl 10(11));

(d) a time-limited Ratio Taskforce, including the union, the employers, the Department of Health and the Chief Nursing and Midwifery Office, supports the rollout (cl 10(4)), and each health service provider or hospital has a Steering Committee with uniform terms of reference (cl 10(14));

(e) workload processes under the model must be "consistent, transparent and visible to all nurses and midwives at the ward or unit level" (cl 10(12)).

The enrolled nurses' and assistants' agreement carries the same ratio commitment (WAH044 cl 12A).

MP 0187/24 is "a mandatory requirement for Health Service Providers under the Clinical Services and Planning Policy Framework pursuant to section 26(2)(c) of the Health Services Act 2016" (MP 0187/24 s 1). A policy framework is binding on each health service provider to which it applies, and on a staff member to whom it applies (Health Services Act 2016 (WA) s 27). It took effect on 30 September 2024 and was last amended on 20 October 2026 (cover page).

The union's journal reported on 14 September 2026 that the metropolitan medical and surgical wards are on 1:4 for morning and afternoon shifts and 1:7 at night, and described the phases so far: the Perth Children's Hospital emergency department pilot (July 2023), Sir Charles Gairdner and Osborne Park (October 2024), medical and surgical wards at eight metropolitan hospitals (July 2025) and metropolitan critical care (February 2026). It also reported that in September 2026 the next stage was delayed with no new date (ANMJ, 14 September 2026). Those figures come from that report, not from the policy. The public record of the delay is on our bargaining and current issues page.

Once ratios have applied on your ward for four months (WAH042 cl 10(10)), the employer, the union or a nurse or midwife can use a four-stage procedure if there is a dispute about ratio requirements being met (cl 10(7)(f), (9)):

1. Stage 1: the line manager responsible for applying the ratio (which may be the after-hours manager or coordinator), "with parties to engage and resolve the concern within the shift" (cl 10(9)(a)).
2. Stage 2: the nominated nursing and midwifery executive (Nursing or Midwifery Director or higher) (cl 10(9)(b)).
3. Stage 3: the health service provider or hospital Steering Committee (cl 10(9)(c)).
4. Stage 4: the WAIRC (cl 10(9)(d)).

"Nothing will prevent either party from applying to the WAIRC at any stage" (cl 10(9)(e)). The policy lists a "Nurse/Midwife to Patient Ratios Workload Concern Escalation Form" as supporting information (MP 0187/24 s 6).

The employer "will provide a safe and healthy work environment and ensure staffing levels are appropriate for the delivery of high-quality patient care" (WAH042 cl 11(1)). It will take reasonable steps so that employees are allocated sustainable workloads, do not work excessive or unreasonable hours, and can take their leave (cl 11(2)–(3)). This clause is not limited to wards without ratios.

An employee, the union or the employer may raise a workload grievance, in writing, on any of six grounds (cl 11(4)):

(a) "an unreasonable or excessive patient care, or nursing or midwifery task workload is being imposed on the employee other than occasionally and infrequently";

(b) to work to a professional standard, the employee is effectively obliged to work unpaid overtime on a regularly recurring basis;

(c) the workload effectively denies reasonably practicable access to professional development time within 12 months of the entitlement arising;

(d) there is no effective consultative mechanism for deciding bed closures or patient workload for the available staff;

(e) a reasonable complaint about capacity to meet mandatory patient care standards has not been responded to or acted on within a reasonable time;

(f) a member or group of a patient care team is consistently placed under an unreasonable or unfair burden, or lacks adequate professional guidance, because of the workload or skill mix.

For ground (a) there is a set process (cl 11(5)):

1. Use the employer's workload form and give it to the line manager (including the after-hours manager or coordinator) (cl 11(5)(a)–(b)).
2. In resolving it, the employer must look at the minimum prescribed Nursing Hours per Patient Day staffing level, the shift staffing profile and the actual staffing on that shift (until the audit findings are final), and explain what it has done or will do to mitigate the problem or prevent it recurring. It may explain verbally within the shift, but must do so in writing within 24 hours if you ask (cl 11(5)(c)).
3. If unresolved, the same four stages as for ratios apply, from the line manager "within the shift" to the WAIRC (cl 11(5)(e)).

You can still raise a concern informally (cl 11(5)(d)). The agreement says a workload grievance raised under cl 11(4) "will be progressed in accordance with clause 73 – Dispute Resolution Procedure" (cl 11(6)), and that nothing prevents the parties applying to the WAIRC, when within jurisdiction, at any time (cl 11(7)).

Clause 12 applies wherever the ratio model has not been applied (WAH042 cl 12(1)). The employer manages workloads in line with a 2001 federal order, the Nurses (WA Government Health Services) Exceptional Matters Order 2001, and its operative duties have effect as if they were express terms of the agreement (cl 12(3)–(4)). The order is reproduced as Schedule A (cl 12(7)). Its central duty is that a nurse's work must not be "a sustained manifestly unfair or unreasonable workload having regard to the skills, experience and classification of the employee and the period over which the workload is imposed", except for urgent emergency work not regularly added to the roster (Sch A cl 5.1).

Under cl 12:

(a) a workload grievance, on the same six grounds, may be raised in writing "by an employee or by the Employer", and goes through the cl 73 dispute procedure (cl 12(6));

(b) every determination of a ward's Nursing Hours per Patient Day category must be published to staff, and the union told in writing within 21 days (cl 12(8)–(9));

(c) the union may, for a member who believes he or she would be prejudiced by raising a grievance personally, ask the employer to review the ward's category. The employer must review it as soon as reasonably practicable and tell the union the outcome in writing within 21 days (cl 12(10)).

The parties have agreed to remove cl 12 and Schedule A from any replacement agreement "when the rollout of the WA Ratio Model is complete, as determined by the Taskforce" (cl 12(2)).

Clause 73 has three internal steps: the manager within three working days, the manager's superior within a further three working days, then the Chief Executive or nominee; if not resolved within five working days of that referral, the employer, the employee or the union may refer it to the WAIRC when within its jurisdiction (WAH042 cl 73(2)(a)–(d)). Work continues as normal while a dispute is resolved, "unless an employee has a reasonable concern about an imminent risk to their health and safety" (cl 73(1)(b)).

The Minimum Conditions of Employment Act 1993 (WA) says an employee is not to be required or requested to work more than their ordinary hours and "reasonable additional hours" (MCE Act s 9A(1)), judged on all relevant factors (s 9B).

The Department of Justice agreement has a single workload clause instead of ratios. It carries the same duty to avoid "a sustained manifestly unfair or unreasonable workload", sets allocation principles (clinical assessment of patient needs, the working environment, safety law, professional standards and "reasonable workloads"), lists indicators to monitor such as accident rate and the incidence of workers' compensation, and has a written workload grievance on similar grounds (DEP187 cl 10(1)–(6)).

WA Health enrolled nurses (other than mental health and mothercraft) and assistants in nursing are covered by the United Workers Union's agreement, not WAH042 (WAH042 cl 4(4)). On nursing workload, the employer recognises that union and enrolled nurses "as parties on equal standing" with the ANMF and registered nurses (WAH044 cl 12C.5).

(a) A personal injury by accident is an injury from employment if it arises out of or in the course of the employment (WCIM Act s 6(2)).

(b) A disease, or the aggravation or acceleration of a pre-existing disease, is an injury from employment if it was contracted in the course of the employment and "the employment contributed to a significant degree" to it (s 6(3)). The factors include the duration of the employment, its nature and tasks, the likelihood of the disease occurring anyway, hereditary factors, your health generally and activities outside work (s 6(4)).

A psychological injury, such as depression, anxiety or a stress disorder, is claimed under the ordinary test: the employment must have contributed to a significant degree (s 6(3)). There is one important exclusion. A psychological or psychiatric disorder is not an injury from employment if it results "wholly or predominantly" from (s 7(2)):

(a) administrative action, unless it was "unreasonable and harsh on the part of the employer"; or

(b) the worker's expectation of administrative action, or of a decision about it.

"Administrative action" includes a performance appraisal, suspension, disciplinary action, and anything done in connection with them or with a demotion, dismissal, retrenchment or failure to obtain a promotion, transfer or other benefit (s 7(1)). The exclusion is aimed at management action. It does not refer to workload, occupational violence or traumatic clinical events.

A presumption shifts the burden: if you have a prescribed disease and work, or have worked, in the prescribed employment for it, the injury "is taken to be injury from that employment unless the employer proves that the injury was not from that employment" (WCIM Act s 10(2)). The prescribed diseases and employment are in Schedule 1 of the WCIM Regulations (r 5).

No PTSD presumption for nurses. PTSD is prescribed only for paramedics, ambulance officers, ambulance emergency communications officers, Crown firefighters and DFES communications systems officers (r 10(2)). A nurse with PTSD claims under the ordinary test in s 6(3).

COVID-19. Prescribed employment includes "employment as a health professional" and "employment, of any kind, in a hospital, medical practice, clinic or facility where persons attend for health-related screening, testing or treatment" (r 9(2)(a)–(b)). The injury is taken to occur on diagnosis by a medical practitioner on a NATA-accredited test result, and the presumption applies to injuries from 16 February 2020 if you were in that employment on that day (r 9(3)–(5)).

Other diseases whose prescribed employment names health care work (Schedule 1, column 2, quoted):

Schedule 1 also lists diseases tied to an exposure rather than an occupation, some of which can arise in health care. Examples are primary leukaemia and bladder cancer after at least 2 or 5 years of exposure to agents including cyclophosphamide or ionising radiation (items 15, 17), occupational asthma after at least 4 weeks of exposure to sensitising agents such as latex or sensitising drugs (item 42; this does not include pre-existing asthma worsened by workplace irritants, note 6), and contact dermatitis after at least 4 weeks of exposure to sensitising agents or irritants (item 46). Whether your work involved the listed exposure is a question of fact.

Conditions that apply to these presumptions:

(a) where Schedule 1 sets a period of employment, it must be completed, in one period or several added together, by the day the injury is taken to have been suffered, whether or not you are still in that employment (r 6);

(b) the injury is taken to have been suffered on the day of first diagnosis by a medical practitioner (r 7);

(c) except for COVID-19 and PTSD, the presumption applies only to an injury taken to have been suffered on or after 1 July 2024 (r 8);

(d) the employer can defeat the presumption by proving the disease was not suffered in the course of the employment, or that the employment did not contribute to it to a significant degree (s 10(2) and its note);

(e) if the presumption does not apply, you can still prove the claim under the ordinary test (s 10(5)).

1. See a doctor and get a certificate of capacity.
2. Give your employer a completed claim form in the approved form and the certificate. That is when the claim is "made" (WCIM Act s 25(2)). Signing the authority to release medical information on the form is optional (s 25(4)).
3. Claim within 12 months after the injury occurs (s 25(1)). A late or defective claim is not invalid if the failure came from mistake, absence from the State or another reasonable cause, or would not prejudice the employer's defence (s 25(5)).
4. An insured employer must give the claim to its insurer within 7 days (s 26(1)).
5. Within 14 days of receiving the claim, the insurer or self-insurer must accept it, accept it with liability questions, dispute it, or give notice that the decision is deferred (s 28(1)–(4)). If it does none of these, it is taken to have accepted liability (s 28(6)). A deferred decision must be made before the day after 120 days from receipt, or liability is again taken to be accepted (s 29(1), (3); Regulations r 19).
6. Once liability is accepted, the first payment of income compensation is due within 14 days and includes payments back to your first day of incapacity (s 47(2)(a)).

(a) Income compensation at your pre-injury weekly rate of income for the first 26 weeks in which it is payable, and 85% of that rate after that, subject to the maximum and minimum rates (s 55(2)–(3)).

(b) In WA Health, while a claim is decided you may use paid personal leave, and if the claim succeeds the personal leave credit is reinstated and the absence is treated as leave without pay (WAH042 cl 38(38)). The clause still refers to the repealed 1981 Act.

(c) At St John of God, personal leave paid for a period later covered by workers' compensation is reinstated when the employer receives the compensation payments (AE530159 cl 38(9)), and superannuation contributions continue for three months while you receive workers' compensation payments (cl 34(5)).

(a) For 12 months from the day you first have an incapacity for work, your employer must give you your pre-injury position, or, if that is not reasonably practicable or you cannot do it, a suitable position most comparable in status and pay (WCIM Act s 166(1)–(2)). This does not apply if you are lawfully dismissed (s 166(3)).

(b) During those 12 months the employer must not dismiss you solely or mainly because you are incapacitated, and must not dismiss you for any reason without first giving you at least 28 days' notice of intention to dismiss in the approved form (s 168(2)–(4)). Each is an offence with a fine of up to $10,000.

A common law claim for damages against your employer needs a permanent whole of person impairment assessed at 15% or more, and a registered election to keep the right to sue (WCIM Act s 421(1)).